The recent release of a white paper by two prominent EMS organizations has renewed long-standing debate in the EMS community about the need for a federal EMS administration and, more specifically, where it should reside.

Submitted in December to Richard Reed, special assistant to the president for Homeland Security and the senior director for Resilience Policy, the paper began circulating online in the EMS community earlier this month. The International Association of EMS Chiefs (IAEMSC) and the National EMS Labor Alliance (EMSLA)—which together represent a broad coalition of public, private and volunteer EMS organizations and union members—collaborated on the paper, titled “Consolidated Federal Leadership for Emergency Medical Services—An Essential Step to Improve National Preparedness: A perspective from EMS on the front line.”

The report’s submission in December is notable, because it parallels the Dec. 17 introduction to the House of Representatives of the oft-debated, long-awaited “Field EMS Bill” (H.R. 6528), which would designate the National Highway Traffic Safety Administration (NHTSA) as the lead agency for EMS. The bill “died” with the lame duck session; however, its backers—led by Advocates for EMS—anticipate its reintroduction this year.

In contrast, the IAEMSC/EMSLA white paper asserts that the Department of Homeland Security Act of 2002 authorized DHS to oversee a federal EMS agency.

Through the Homeland Security Act of 2002, Public Law 107-296, the Department of Homeland Security has not only the authority, but also the responsibility to ‘ensure the effectiveness of emergency response providers to terrorist attacks, major disasters, and other emergencies’ (Public Law 107-296, Title 5 section 502 subsection 1). Within section 2 (6) of the Act, ‘the term “emergency response providers” includes federal, state and local emergency public safety, law enforcement, emergency response, emergency medical (including hospital emergency facilities), and related personnel, agencies and authorities.’ DHS Management Directive 9100 organizes the roles and responsibility outlined herein, within the office of the DHS Under Secretary for Emergency Preparedness and Response.

“The paper was a product of the IAEMSC’s annual summit, which was held in October in Washington, D.C.,” says IAEMSC President Lawrence Tan, JD, NREMT-P, and chief of EMS for the New Castle County (Del.) Department of Public Safety. “One of the members of the national security staff came to talk about the development of national preparedness policy and the potential impact on EMS. At the conclusion of the presentation, he stayed, rolled up his sleeves and got into a very interactive discussion with the participants at the summit.”

Tan says the topic led to a candid discussion about the fragmentation of EMS as a whole and how it impedes the development of national preparedness policy. “The group was asked to look at offering solutions,” he says. “The white paper was a response to a recommendation to develop it and prepare it.

“In the session, there were representatives from the National EMS Labor Alliance. If you look at the issues that have surrounded the EMS profession, clearly, we all have some common ground. So there was collaboration between the two organizations.”

EMSLA President Jamie Orsino says the real task the two associations faced was “one of commitment to a process of looking at what everyone in EMS has agreed to for a long time—the need for federal EMS leadership—and developing the most effective and efficient strategy for implementation without getting lost in the weeds of hundreds of different sub-sectors and separated agendas. EMS was measured simply as the vital service that we all deliver to the nation.”

The resulting white paper discusses the history and present state of EMS, its fragmentation and need for centralized federal guidance, and the existing authority for an EMS administration under the Department of Homeland Security:

The purpose of this white paper is to outline a clear path for consolidated federal leadership of EMS in America and to delineate actions for improving the effective, efficient and equitable delivery of EMS under all conditions and for all hazards. The basis for this federal leadership consolidation for EMS currently exists in policy. The Department of Homeland Security, specifically the Under Secretary of Emergency Preparedness and Response, has the authority to establish and oversee federal EMS administration. Leveraging this authority will have a resounding positive effect on the over 16 million patients transported by EMS agencies each year, as well as the many others who benefit from EMS services other than transport each year.

Notably, the paper provides several recommendations that parallel provisions included in the Field EMS Bill. In addition to establishing a lead federal agency for EMS (albeit via a different means), the white paper recommends:

National EMS Systems Improvement: This includes evidence-based national standards for EMS system performance measurement; establishment of a national EMS Academy; enhanced data collection; EMS leadership competencies; public accountability and transparency; workforce training and development programs consistent with national improvements; regionalization of EMS; maintenance of critical workforce levels; and advocacy for and advancements in personnel and patient safety.

A National Role within Existing Core Mission of EMS: This includes enhanced national capability to deliver consistent prehospital care to all; national support for EMS’s ability to mitigate, prepare for and respond to all incidents and hazards without jeopardizing other core responsibilities; integration of EMS into the National Response Framework as a distinct entity; enhanced capability to conduct research on the national EMS workforce and its response and readiness capabilities; the implementation and maintenance of evidence-based medical oversight; and the use the grant funding to identify and implement national EMS safety standards, procure safety equipment, and train EMS in its use.

Expanded Health Care Mission: This includes the expanded role of health care services in accordance with health care reform; evidence-based medical oversight of national EMS expanded roles; planning for mitigating health services during public health emergencies; implementation of regionalized EMS systems; and research into new interventions and technology to support an expanded health care mission.

EMS Funding: This includes identification of health-care system cost savings through EMS health care; identification of potential cost savings through expanded EMS mission interventions; determination of the actual cost of providing timely, effective and equitable EMS health care; realignment of federal reimbursements of EMS based on realized savings and the actual costs of delivery; establishment of incentive research grants to improve patient outcomes and reduce health care costs; establishment of grant funds to maintain critical national EMS workforce levels and response capabilities; and establishment of grant funding programs for equipment and training to improve workforce and patient safety.

“The majority of the white paper talks about things we agree on,” says Kurt Krumperman, MS, NREMT-P, president of Advocates for EMS—the group that led the introduction of the Field EMS Bill. “There’s fundamental agreement on some of the things that we need federal leadership to help with, and why we need legislation. There is obviously a difference of opinion related to the issue of where a lead or a primary [EMS] agency should be located. But there is agreement that there’s a need for one.” (Read the Field EMS Bill at www.advocatesforems.org.)

“They’re making the argument that the authority already exists, that’s it’s a matter of doing it,” Krumperman says. “I’m just not confident about that being the case, and whether that’s exactly how those in Washington, both the administration and the legislature, would see it.” He adds that it’s the right time to continue discussing the issue and that AEMS welcomes further conversation about the best location for an agency. “We really encourage the continued discussion and debate because in the end, what we’re interested in is not where it is; we’re interested in that it is.”

Tan agrees that the Field EMS bill and the white paper complement each other, but “the reality is that Advocates for EMS and the Field EMS Bill are looking at a potential solution from the legislative branch side. Our white paper looks at existing statutory authority to accomplish the fundamental goal of designating a lead federal agency with responsibility for EMS through existing legislation that’s already on the books. That being the case, it may be a faster way to accomplish the same goal and get thing started.”

Continued discussionWith both a major piece of proposed legislation and this new white paper in circulation, the EMS community is primed for in-depth discussion and, perhaps, definitive action to finally address the void in federal EMS leadership that the EMS community agrees currently exists. The white paper was submitted in December and forwarded to the Federal Interagency Committee on Emergency Medical Services (FICEMS). FICEMS has been asked to develop its own white paper—which will surely take into account the Field EMS Bill and the IAEMSC/EMSLA white paper—presenting policy options for a lead federal agency for EMS. The paper is expected to be delivered to national security staff within the Executive Office of the President no later than May 16, 2011.

Orsino says he’s optimistic the “unprecedented level of labor/management cooperation and trust” achieved while developing the white paper will continue as the EMS community explores solutions.

“Everyone left their hats, titles and agendas at the door, and the consistent theme was that the end result would overshadow the credit,” he says. “If EMS maintains these ideals moving forward and concentrates on the overarching and long-agreed-upon goal of consolidated federal leadership for EMS, then the future certainly holds a more effective, equitable and efficient EMS system for the nation.”